JACC:他汀不耐受与心梗复发和冠心病风险增加相关?

2017-05-09 吴星 环球医学编

2017年3月,发表在《J Am Coll Cardiol》的一项由罗马尼亚、美国和波兰科学家进行的研究,考察了他汀耐受性与心梗后冠脉心脏事件和全因死亡的相关性。


2017年3月,发表在《J Am Coll Cardiol》的一项由罗马尼亚、美国和波兰科学家进行的研究,考察了他汀耐受性与心梗后冠脉心脏事件和全因死亡的相关性。

背景:许多患者报告了他汀治疗的不良反应和对他汀治疗的不耐受。这些患者的冠心病(CHD)事件风险和死亡风险可能增加。

目的:该研究评价了他汀不耐受的Medicare受益者,以及对他汀治疗依从性较高的人群中,心梗(MI)复发、CHD事件和全因死亡的风险。

方法:研究者评价了2007年至2013年因MI住院的患者在出院后,开始中度或高强度他汀剂量的105329例Medicare受益者。他汀不耐受定义为下调他汀滴定剂量,并起始依折麦布疗法,从他汀转换为依折麦布单药疗法,出现国际疾病分类第9次修订版中横纹肌溶解或降脂不良事件的诊断代码,随后下调他汀滴定剂量,或中断他汀治疗,或在起始治疗后1年内转换使用≥3类他汀药物。出院后高剂量他汀依从性定义为覆盖的天数比例≥80%。MI复发、CHD事件(MI复发或冠状动脉血管重建术)和死亡定为出院后1年至2014年12月。

结果:总体而言,1741例患者(1.65%)出现他汀不耐受,55567例患者(52.8%)对他汀有较高的依从性。在中位1.9至2.3年的随访中,出现4450次MIs复发、6250次CHD事件和14311例死亡。与他汀依从性较高的受益者相比,他汀不耐受与MI复发率增加36%(分别为41.1 vs 30.1每1000人-年)、CHD事件增加43%(分别为62.5 vs 43.8每1000人-年)以及全因死亡率降低15%(分别为79.9 vs 94.2每1000人-年)相关。比较他汀不耐受受益者与他汀依从性较高受益者的校正多变量风险比(HR)为:MI复发1.50(95%置信区间[CI]:1.30~1.73),CHD事件1.51(95% CI:1.34~1.70),全因死亡率0.96(95% CI:0.87~1.06)。

结论:他汀不耐受与MI复发以及CHD事件风险增加相关,但与全因死亡不相关。

原始出处:


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    2017-11-09 hbwxf
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    2017-05-27 1e145228m78(暂无匿称)

    学习了,谢谢作者分享!

    0

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    2017-05-09 1e1b8538m79(暂无匿称)

    结论为不相关

    0

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